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  • Writer's pictureThe Virtual Doctors

Striving for Universal Health Coverage in Zambia: Telemedicine puts policy to practice.


Donal Farrell one of our volunteer doctors highlights the value of telemedicine and how it get be used to combat health inequalities in remote areas.






Zambia’s population has grown from 13.1 million in 2010 to over 19.6 million in 2022, with 60% of the population living in rural areas (ZamStats, 2022). With 11.2 doctors, nurses, and midwives per 10,000 people, Zambia’s health care workforce is well below WHO recommendations of 22.9 per 10,000 people (Zambia MoH, 2018).

As one of the world’s youngest countries by median age and an expectation of continued rapid growth rate of 2-3% per year (World Bank, 2023), there is an expectation of a health care worker shortfall to the tune of 46,000 by 2035 (Kamwanga et al., 2013).


Ranking among the countries with the highest levels of poverty and inequality globally (World Bank, 2023), Zambia’s health system has had to adapt and innovate to address the care needs of its population. A crucial component to these efforts has been measures taken to improve the recruitment and retention of health workers in rural settings (Gow et al., 2013).


In addition to increasing the number of trained doctors, nurses, and midwives, Zambia has trained increasing numbers of non-physician clinicians to fulfil a variety of critical roles within the healthcare system (SHEPIZ, 2022).


Clinical Officers form the lion’s share of this non-physician cohort, completing a three year Diploma in Clinical Medicine General, focussing on clinical skills and community-based activities.




The aim is to produce Clinical Officers who can competently provide curative and preventative services, complete relevant health administrative duties, and refer appropriately to the next level of care (HPCZ, 2023). The vast majority of Clinical Officers are employed in rural settings, with limited direct access to clinical and educational support.


Zambia’s Minister of Health, Sylvia Masebo, has outlined her Ministry’s commitment to strengthening service delivery at the primary care level, including the recruitment of a trained and motivated workforce (Zambia MoH, 2023).


Contributions from Sylvia Masebo to the World Health Assembly in Doha {May 2023} and to the WHO Regional Committee for Africa {Aug 2023} have underscored her Ministry’s commitment to prioritising primary health care (WHO Africa, 2023), with a recognition of the enduring contributory role of ‘third’ sector (non-governmental and not-for-profit) collaborations in turning these policy level aspirations into front-line practice (WHO WHA, 2023). 



Against this backdrop, perhaps it is no wonder that telemedicine services (the use of digital technology to overcome distance barriers in the delivery of healthcare) in Zambia have undergone much challenge and change over the years.


The Virtual Doctors is one such example, migrating from a mobile clinic in 2009 (set up from the back of a vehicle, including the use of a hard-wearing laptop and a satellite terminal unit to access advice from remote ‘virtual’ doctors) (Mupela et al., 2011), to what is now a custom built application on smartphones that connects rural health workers, primarily clinical officers, from 288 health facilities in Zambia (and 21 in Malawi) to volunteer ‘virtual’ doctors, to help with the diagnosis and management of complex cases.


The continued success and growth of the Virtual Doctors service can be attributed not only to the small, but experienced and committed Zambian staff, the willingness of the clinical officers to engage with the platform, and for the volunteer doctors to respond promptly (aim is within 24 hours), but also to the close collaboration with Zambia’s Ministry of Health from the outset (e.g. there is an existing Memorandum of Understanding with the Ministry).



With funding relying entirely on charitable donations, the willingness to partner with other organisations has allowed Virtual Doctors to advance their vision of enhancing healthcare provision to rural communities. A recent partnership with Geeks Without Frontiers, seeks to take advantage of their goal to bring internet connectivity to the next 50% of the world population.


Funding from Johnson and Johnson for the development of the soon to be launched updated app, including expansion of the app based medical resource library for Clinical Officers, provides an example of how third sector collaboration remains crucial in co-creating solutions (i.e. by responding to feedback and demand).


With high approval ratings from Clinical Officers and with 94% of Clinical Officer respondents finding the service educational (Virtual Doctors, 2023), it is no surprise that long-standing users such as Pecidah Chikonde, a Clinical Officer based at Nampundwe Rural Health Centre, Central Province, Zambia is a Virtual Doctor advocate


“It has been a tremendous journey. The Virtual Doctors have given me more confidence because working in a rural area is not easy. They have also added to my skills and knowledge, that is why I rely on the VDrs consultations.” – Pecidah Chikonde (2018)

From the dizzy heights of policy level discussions in Doha to the day to day clinical decisions in rural health clinics in Zambia, telemedicine promises to be an important ingredient in the future mix of achieving Universal Health Coverage through health workforce strengthening (WHO, 2022).

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Dr Donal Farrell is undertaking the Technology Enhanced Learning module at Medics.Academy.



References

-           Geeks Without Frontiers. The N50 Project. Available at https://www.geekswf.org/n50 (Accessed 12 Dec 2023)


-           Gow, J. et al. (2013) “An evaluation of the effectiveness of the Zambian Health Worker Retention Scheme (ZHWRS) for rural areas.” African health sciences vol. 13, pp 800-7. doi: 10.4314/ahs.v13i3.40


-           Health Professions Councill of Zambia (HPCZ) (2023). Core competencies reference manual for Clinical Officer General to practise in Zambia. Available at https://www.hpcz.org.zm/wp-content/uploads/2023/08/7f.-COG-CCRM.pdf (Accessed online 12 Dec 2023)


-           Hon. Sylvia T. Masebo, Speech for the official launch of the 2022 – 2026 National Health Strategic Plan, Ministry of Health, Zambia (2023). Available at https://www.moh.gov.zm/?p=3145 (Accessed 12 Dec 2023)


-           Kamwanga, J. et al. (2013). “Understanding the labour market

of human resources for health in Zambia.” WHO Technical Document, Global Health Workforce Alliance. Available at https://www.who.int/publications/m/item/2013-zambia-hlm (Accessed 12 Dec 2023)


-           Mupela, E., Mustarde, P., and Jones, H. (2011). Telemedicine in primary health: the Virtual Doctors Project Zambia. Philosophy, ethics, and humanities in medicine, 6: 9. doi: 10.1186/1747-5341-6-9


-           Republic of Zambia Ministry of Health (2018). National human resources for health strategic plan (2018 – 2022). Available at https://platform.who.int/docs/default-source/mca-documents/policy-documents/plan-strategy/ZMB-MN-74-01-PLAN-STRATEGY-2018-eng-Natl-Human-Resources-for-Health-Strategic-Plan-2018-2022.pdf (Accessed 12 Dec 2023)


-           SHEPIZ, MJZ. (2022). Strengthening health education professionals workforce in Zambia. Medical Journal of Zambia Special Issue doi: 10.55320/mjz…253


-           The World Bank in Zambia (2023). Country overview, The World Bank. Available at https://www.worldbank.org/en/country/zambia/overview (Accessed 12 Dec 2023)


-           Virtual Doctors (2023). Donor Reports. Available at https://www.virtualdoctors.org/donor-reports (Accessed 12 Dec 2023)


-           Virtual Doctors (2023). Overview and update reports. Available at http://tinyurl.com/4hxjvp6c and http://tinyurl.com/39rj68kj (Accessed 12 Dec 2023)


-           WHO (2022). Consolidated telemedicine implementation guide. Geneva: World Health Organisation. Available at https://www.who.int/publications/i/item/9789240059184 (Accessed 12 Dec 2023)


-           WHO Director-General’s report to member states at 76th World Health Assembly (2023). Available at https://www.who.int/about/accountability/governance/world-health-assembly/seventy-sixth-world-health-assembly (Accessed 12 Dec 2023)


-           WHO Regional committee for Africa, 73rd Session (2023) Framework for sustaining resilient health systems to achieve universal health coverage and promote health security 2023 – 2030 in the WHO African region. Available at https://www.afro.who.int/about-us/governance/sessions/seventy-third-session-who-regional-committee-africa (Accessed 12 Dec 2023)


-           Zambia Statistics Agency (ZamStats) (2022), Census of Population and Housing, ‘Everyone Counts’. Available at https://www.zamstats.gov.zm/ (Accessed 12 Dec 2023)

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